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Rimantadine hydrochloride
Rimantadine hydrochloride (Flumadine)
Rimantadine hydrochloride
(rih-MAN-tih-deen)
Pregnancy Category: C Flumadine (Rx)

Classification: Antiviral agent

See Also: See also Antiviral Drugs and Amantadine hydrochloride.

Action/Kinetics: May act early in the viral replication cycle, possibly by inhibiting the uncoating of the virus. A virus protein specified by the virion M₂ gene may play an important role in the inhibition of the influenza A virus by rimantadine. Has little or no activity against influenza B virus. Plasma trough levels following 100 mg b.i.d. for 10 days range from 118 to 468 ng/mL; however, levels are higher in clients over the age of 70 years. Metabolized in the liver, and both unchanged drug (25%) and metabolites excreted through the urine.

Uses: In adults for prophylaxis and treatment of illness caused by strains of influenza A virus. In children for prophylaxis against influenza A virus.

Contraindications: Hypersensitivity to amantadine, rimantadine, or other drugs in the adamantine class. Lactation.

Special Concerns: Use with caution in clients with renal or hepatic insufficiency. An increased incidence of seizures is possible in clients with a history of epilepsy who have received amantadine. Influenza A virus strains resistant to rimantadine can emerge during treatment and be transmitted, causing symptoms of influenza. Safety and efficacy of rimantadine in the treatment of symptomatic influenza infections in children have not been established. Safety and efficacy for prophylaxis of infections have not been determined in children less than 1 year of age. The incidence of side effects in geriatric clients is higher than in other clients.

Side Effects: GI and CNS side effects are the most common. GI: N&V;, anorexia, dry mouth, abdominal pain, diarrhea, dyspepsia, constipation, dysphagia, stomatitis. CNS: Insomnia, dizziness, headache, nervousness, fatigue, asthenia, impairment of concentration, ataxia, somnolence, agitation, depression, gait abnormality, euphoria, hyperkinesia, tremor, hallucinations, confusion, convulsions agitation, diaphoresis, hypesthesia. Respiratory: Dyspnea, bronchospasm cough. CV: Pallor, palpitation, hypertension, cerebrovascular disorder, cardiac failure pedal edema, heart block, tachycardia, syncope. Miscellaneous: Tinnitus, taste loss or change, parosmia, eye pain, rash, nonpuerperal lactation, increased lacrimation, increased frequency of micturition, fever, rigors.

Overdose Management: Symptoms: Extensions of side effects including the possibility of agitation, hallucinations, cardiac arrhythmias, and death. Treatment: Supportive therapy. IV physostigmine at doses of 1-2 mg IV in adults and 0.5 mg in children, not to exceed 2 mg/hr, has been reported to be beneficial in treating overdose for amantadine (a related drug).

Drug Interactions: Acetaminophen / Peak concentration and area under the curve for rimantadine Aspirin / Peak plasma levels and area under the curve for rimantadine Cimetidine / Clearance of rimantadine

How Supplied: Syrup: 50 mg/5 mL; Tablet: 100 mg

Dosage
•Syrup, Tablets Prophylaxis.
Adults and children over 10 years of age: 100 mg b.i.d. In clients with severe hepatic dysfunction (C_CR < 10 mL/min) and in elderly nursing home clients, reduce the dose to 100 mg/day. Children, less than 10 years of age: 5 mg/kg once daily, not to exceed a total dose of 150 mg/day.
Treatment.
Adults: 100 mg b.i.d. In clients with severe hepatic dysfunction and in elderly nursing home clients, reduce the dose to 100 mg/day.